Dissertation Title
John Doe
John Doe University
A Clinical Research Project presented to the faculty of John Doe University in partial
fulfillment of the requirements for the degree of Doctor of Psychology in Clinical
Psychology.
July, 2013
Abstract
VIVITROL® is the only first once a month extended-release injectable medication for
treating alcohol dependence. It was approved by F.D.A in april of 2006. VIVITROL®
targets psychosocial and physical drivers of chronic, unhealthy drinking and is effectively
adjuncts to the treatment of alcohol dependence. However, adherence to substance-abuse
medication is the major concern, because the high rates of nonadherence limits the
benefits that could be realized from this type of medication-assisted treatment. My study
was an adjunct to larger study, with UCLA Integrated Substance Abuse Programs; and
the Substance Abuse Prevention and Control office (SAPC) Tarzana Treatment Centers
Inc. been asked by UCLA and SAPC to investigate if VIVITROL® can be used to help
to improve the treatments offered of Los Angeles County programs. The larger study,
with UCLA and SAPC aims to tracking clients who have accept VIVITROL® treatment,
in an effort to identify: ways it could be used more frequently for clinical practice. A
goal of this specific added on study was to identify characteristics of the patients who
more likely to denied VIVITROL® treatment, in order to identify the themes and the
barriers to their treatment that also might inform future recommendations on how
addressing these barriers.
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Table of Contents
Abstract.............................................................................................................................. ii
Table of Contents ............................................................................................................. iii
Chapter 1: Introduction ....................................................................................................5
Background of the Problem ........................................................................................5
Statement of the Problem .............................................. Error! Bookmark not defined.
Chapter 2: Literature Review ............................................. Error! Bookmark not defined.
Urge to Drink.................................................................. Error! Bookmark not defined.
Personality Traits and Alcohol ..................................... Error! Bookmark not defined.
Alcohol Dependence and Psychosocial Interventions . Error! Bookmark not defined.
VIVITROL® and Psychosocial Interventions ............ Error! Bookmark not defined.
Chapter 3: Methods ............................................................. Error! Bookmark not defined.
Participants ..................................................................... Error! Bookmark not defined.
Procedure ........................................................................ Error! Bookmark not defined.
Measures ......................................................................... Error! Bookmark not defined.
Chapter 4: Results................................................................ Error! Bookmark not defined.
Hypothesis Testing ......................................................... Error! Bookmark not defined.
Post Hoc Analysis Results ...........................................................................................6
Chapter 5: Discussion .......................................................... Error! Bookmark not defined.
Clinical Implications ...................................................... Error! Bookmark not defined.
Limitations ...................................................................... Error! Bookmark not defined.
Future Recommendations ............................................. Error! Bookmark not defined.
References ...........................................................................................................................9
Appendix: Informed Consent Form ................................... Error! Bookmark not defined.
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Chapter 1: Introduction
Alcohol dependence is known as neurobiological disease and the third leading
cause of depression and of death in the United States (Krishnan-Sarin, O’Malley, &
Krystal, 2008). According to the Substance Abuse & Mental Health Services
Administration (2006), about 19 million adults (7.7%) in the United States abused or
dependent on alcohol in just 2005 alone. Only 1.6 million people reports receiving
treatment for alcohol dependence, and even fewer receive medication-assisted treatment
(Substance Abuse and Mental Health Services Administration, 2006). Interest of alcohol
treatment continues to growing, which is due to alcohol-dependence persisting as a
chronic medical disease which most typically entails frequently relapses and bad
adherence to treatment. In order to, address the major problems associating with relapse
and poor adhreence, research is increasing surrounding use of pharmacotherapy or
medication-assisted treatment in alcohol dependence (Swift 2007).
Background of the Problem
The primary interventions to be for addressing alcohol dependence are mainly
psychosocial, or also known as non-medication-assisted treatments. These include:
substance abuse counseling; spiritually based approaches, like as Alcoholics Anonymous
(Cutler & Fishbain, 2005; Williams, 2005); and more recently, motivational interviewing
(Lundahl & Burke, 2009). Unfortunately, a big number of patient fail to complete
psychosocial treatment that is because of thier relapse or poor adherence (Swift, 1999),
and evidences suggests psychosocial interventions used by alone aren’t effective to
everyone (Kenna, McGeary, Swift 2004).
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Post Hoc Analysis Results
Since the hypothesises were not supported, post hoc analyses were run involving
Pearson correlations among all variables for determine whether if there were any
significant relationship. When post hoc analysis was conducted, some significant
relationships were observed for all 3 hypotheses.
The results in Table 1 illustrating the significant correlations between baseline
Urge to Drink score, and Urge to Drink score in the second and 3rd months for
Hypothesis 1. Baseline Urge to Drink score and Urge to Drink score in the 2nd month as
significantly correlated at r = .754, p < .01. As the baseline, Urge to Drink score
increased, so did Urge to Drink score in the second month. Baseline Urge to Drink Score
and Urge to Drink Score in 3rd month were as well significant correlated at r =.617, p <
.05. And also, the Urge to Drink score in the second month and Urge to Drink score in
the third month were significantly correlated at r = .942, p < .01. As the Urge to Drink
score increased in the second months, Urge to Drink increased in third month.
Additionally, there was to be found significant correlations between negative affect and
Urge to Drink scores in the second month (r = .537, p < .05) and in the third month (r =
.548, p < .05).
Table 1: Significant
Correlations of Participants’
UTD Baseline
Time2 Time3
Baseline
.754**
.617*
Pearson
.002
.019
Correlation
14
14
2nd month
and 3rd Month Scores
7
Sig. (2tailed)
N
Negaffect
.537*
.548*
Pearson
.048
.043
Correlation
14
14
Sig. (2tailed)
N
Note. *Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level
(2-tailed)
The results in Table 2 illustrate significant correlations found between the
personality characteristics of the negative affect and acting out, negative affect and hostle
control, and of the health problems and suicidal thinking for Hypothesis 2. Negative
Affect and Acting Out personality characteristics were significantly correlated at r = .675,
p < .01. As negative affect increased so did acting out personality traits. Negative Affect
and Hostile Control also significantly correlated at r = .573, p < .01. As negative affect
increased so did hostile control personality traits. Health problems and Suicidal thinking
were also significantly correlated at r = .599, p < .01. As health problems went up so did
suicidal thinking. See the Table 2.
Table 2
Significant Correlations of PAS scores
Actingout
Hostile
Suicidal
Control
Thinking
8
Negaffect Pearson Correlation
Sig. (2-tailed)
N
Healthprob Pearson Correlation
Sig. (2-tailed)
N
.675**
.573*
.008
.032
14
14
.599*
.024
14
Note. *Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2tailed)
9
References
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Anton, R., O’Malley, S., Ciraulo, D., Cisler, R., Couper, D., Donovan, D., . . . Zweben,
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Cannon, D., Keefe, C., & Clark, L. (1997) Persistence predicts latency to relapse
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